Opioid Therapy for Chronic Noncancer Back Pain
- 1 December 1998
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 23 (23), 2591-2600
- https://doi.org/10.1097/00007632-199812010-00014
Abstract
A randomized, open, long-term, repeated-dose comparison of an anti-inflammatory drug and two opioid regimens in 36 patients with back pain. To examine the long-term safety and efficacy of chronic opioid therapy in a randomized trial of patients with back pain. All participants underwent a 4-week washout period of no opioid medication before being randomly assigned to one of three treatment regimens for 16 weeks: 1) naproxen only, 2) set-dose oxycodone, or 3) titrated-dose oxycodone and sustained-release morphine sulfate. All patients then were assigned to a titrated dose of opioids for 16 weeks and then gradually tapered off their medication for 12 weeks. Finally, all participants were monitored for a 1-month posttreatment washout period. Each patient was called once a week for a report on pain, activity, mood, medication, hours awake, and adverse effects and was monitored carefully for signs of abuse and noncompliance. Weekly reports during the experimental phase showed the titrated-dose group to have less pain (P < 0.001) and less emotional distress (P < 0.001) than the other two groups. Both opioid groups were significantly different from the naproxen-only group. During the titration phase, patients also reported significantly less pain and improved mood. Few differences were found in activity or hours asleep, or between average pretreatment and posttreatment phone-interview and questionnaire variables. No adverse events occurred, and only one participant showed signs of abuse behavior. The results suggest that opioid therapy has a positive effect on pain and mood but little effect on activity and sleep. Opioid therapy for chronic back pain was used without significant risk of abuse. However, tapered-off opioid treatment is palliative and without long-term benefit.Keywords
This publication has 18 references indexed in Scilit:
- Chronic Pain-Associated Depression: Antecedent or Consequence of Chronic Pain? A ReviewThe Clinical Journal of Pain, 1997
- The use of opioids for the treatment of chronic painPain Forum, 1997
- Chronic opioid therapy for nonmalignant pain in patients with a history of substance abuse: Report of 20 casesJournal of Pain and Symptom Management, 1996
- Response to Controversy CornerThe Clinical Journal of Pain, 1991
- A new drug law for the states: An opportunity to affirm the role of opioids in cancer pain reliefJournal of Pain and Symptom Management, 1990
- Outpatient Treatment of Patients with Chronic Pain An Analysis of Cost SavingsThe Clinical Journal of Pain, 1989
- Empirically derived Symptom Checklist 90 subgroups of chronic pain patients: A cluster analysisJournal of Behavioral Medicine, 1988
- Screening for alcohol abuse using the cage questionnaireAmerican Journal Of Medicine, 1987
- Evaluation of a daily activity diary for chronic pain patientsPain, 1984
- Problems with the use of oxycodone compound in patients with chronic painPain, 1981